Cytological diagnosis of erythema nodosum leprosum in clinically unsuspected cases: A report of two cases

Abstract

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The manifestations of this disease varies across the spectrum of tuberculoid (TT) to lepromatous (LL) leprosy. The course of this indolent disease is interrupted by acute exacerbations in the form of leprare actions. Erythema nodosum leprosum (ENL), a type 2 lepra reaction, occurs in lepromatous or borderline lepromatous cases, usually in response to multidrug therapy. Early detection and timely management of these patients is important to reduce the associated morbidity. We report two clinically unusual cases of ENL on fine-needle aspiration cytology. In one case, antileprosy treatment was completed 10 years back, whereas in the other case, ENL was the presenting feature of the disease. Cytological examination of swelling in both the cases showed neutrophils, lymphoid cells, clusters of foamy macrophages, histiocytes, and giant cells. Fite stain was positive, which confirmed the cytological diagnosis of ENL.

Erythema nodosum leprosum as presenting feature of lepromatous leprosy

“…All findings were secondary to a rare presentation of leprosy known as ENL, which generally occurs in lepromatous leprosy cases and rarely in borderline cases. Young patients with high bacillary index and skin infiltration like the patient presented above are more prone to developing these reactions [5].…”

Hubungan Faktor Risiko Dengan Kejadian Erythema Nodosum Leprosum (Enl) Di Rsup DR Mohammad Hoesin Palembang

“…Erythema Nodosum Leprosum (ENL) adalah komplikasi kusta berupa reaksi hipersensitivitas tipe III dengan peradangan akut karena respon berlebihan tubuh terhadap M. leprae. 6 Berdasarkan data WHO banyaknya pasien yang terkena reaksi kusta tipe ENL hingga timbul deformitas, didominasi oleh tipe MB sebanyak 67.160 kasus. 4 Erythema Nodosum Leprosum (ENL) pada umumnya terjadi pada pasien kusta tipe lepromatous seperti BL (10%) dan LL (50%).…”